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Physician Assistants Associates: the new clinical profession PA education & training

Physician Assistants Associates: the new clinical profession PA education & training. Jim Parle, Course Director, PA PgDip Chair of UKIUBPAE University of Birmingham December 2013. A Physician Assistant is

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Physician Assistants Associates: the new clinical profession PA education & training

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  1. Physician Assistants Associates: the new clinical professionPA education & training Jim Parle, Course Director, PA PgDip Chair of UKIUBPAE University of Birmingham December 2013

  2. A Physician Assistant is “…a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and /or general practice team under defined levels of supervision.” (The Competence and Curriculum Framework for the Physician Assistant, Dept. of Health, 2006; recently revised)

  3. How does a Physician Assistant (PA) work? • to the medical model and ‘credentialed’ to practice medicine with physician supervision • within the scope of practice of their supervisor • as dependent practitioners • in a relationship between doctor and PA which is based on mutual trust and respect.

  4. What do PAs do? • Work like doctors • Listen/gather information • Differential diagnosis • Investigations if needed • Treat/counsel/medicate/refer

  5. Consultants Increasing acuity and complexity Consultants provide supervision senior trainees Care delivered directly or appropriately supervised by a permanent medical team familiar with the unit Senior Trainees contribute to supervision / training of the Permanent Medical Team permanent (non-consultant) medical team Those moving from other disciplines into training ED patients Those gaining experience in as part of other training programmeFY1/2; GP trainees Those in training to be part of the permanent medical team Those in specialist training with the intention of gaining an consultant post patient care Improving the experience of patients and trainees through the development of a broad-based permanent non-consultant medical team.Authors: Parle J and Ross N, University of Birmingham, September 2012 .

  6. USA – now a 40+ year history ~100,000 qualified Canada (e.g. Military and now others: McMaster) The Netherlands (n~700 from 5 programmes) Australia (e.g. James Cook) South Africa Similar professions worldwide e.g. Ghana PAs globally

  7. Background to West Midlands programme development • Initial interest from the NHS locally • Department of Health involvement: steering group • Jointly chaired by Royal College of Physicians & Royal College of GPs • NHS/patient/UoB membership • West Midlands NHS backing (“SIFT”)

  8. DH specification for PA education Competence and Curriculum Framework 2012 CompetenciesProcedural SkillsMatrix of Conditions Programme Specification ~ 3200 hours over 2 yrs~ 50% clinical (incl. 200 simulation hours)~ 50% theory http://www.ukapa.co.uk/files/CCF-27-03-12-for-PAMVR.pdf

  9. Who are they? • All are graduates • Backgrounds in health or life sciences • Average age ~30 • ~2/3rd are female

  10. Theory focus General Practice Clinical focus Hospital Holiday Clinical Skills/simulation Calendar Year UoB course: 46 weeks per year, F/T

  11. Expertise in Communication Skills National Core High level of Sickle Cell Anaemia in Population National Centre for Immunology National assessment Institutional Core Scope for student selection

  12. UoB student placements (current in italics; outside WM in red) • Heartlands & Solihull & Good Hope; • City & Sandwell; • Dudley group • University Hospital Birmingham • Walsall • Shrewsbury and Telford • Leicester Royal Infirmary • George Eliot • Stafford • Women’s, Children’s, mental health trusts • Northampton • GPs++

  13. UK intakes • (very small numbers pre-2008) • 2008: 15 UoB + 13 UoW + 15 St. George’s: 43 • 2009: 59 • 2010: 66 • 2011: 21 St George’s + 11 Aberdeen medical school: 32 • 2012: 39 • 2013: 44 • 2014: 44 + 30 UoB +?20 Worcester + ?20 Wolverhampton (~110) • 2015: ?36 St George’s +?26 Aberdeen +?80 UoB +?20 Worcester +?20 Wolverhampton +?20 Barts +?20 Exeter +?20 Plymouth: (~240) • others preparing business cases and others considering

  14. NHS / Trust / HE relationship • Who pays in West Midlands: • Currently students (small HE contribution) • Trusts pro bono/pro Trust! • GPs paid opportunity cost • Sustainability? • New grads coming with bigger debts • HE/Gov’t HAS to fix: • ‘loans’ • Bursaries • As per graduate entry medicine

  15. Commissioned? • Old style model? • Flexible enough? • What about sponsoring/educational contracts? Student placement = long (mutual) interview!

  16. Employment • ~200 or so PAs • ~35 Trusts ~30 GPs • Wide range of specialties • Most started at 30k (ie ‘Band 7’ 30-40k) • A few at Band 6 (25-30k) internship • 3 at Band 8 (40-47k)

  17. UoB grad Physician Assistant posts in UK Hospitals (excl. GPs) ScotlandLothian University Hospital MidlandsUniversity Hospitals of Leicester George Eliot Hospital Solihull & B’ham Mental Health University Hospitals B’ham Sandwell & W. B’ham Hospitals Walsall Healthcare Dudley Group of Hospitals Mid StaffordshireShrewsbury & Telford Hosps South & London St George’s Healthcare Royal National Orthopaedic HospNorth West London Hosps (Northwick Park) Weston Area Health (Somerset) Great Western Hospitals (Swindon) Kingston Hospitals Epsom & St Helier University Hosp

  18. Current Issues Regulation & prescribing Managed Voluntary Register → statutory register Prescribing as integral to role rather than extension Registering Body HCPC? / GMC? Reaccreditation First iteration of national licensing examination

  19. Reaccreditation • US model • Maintains PAs’ flexibility • ‘stem cell’ • 6 yearly cycle • CPD • Re-examination in basic knowledge 200 mcq questions As NHS needs change, so can PAs’ skill set

  20. Royal Colleges • Royal College Physicians Faculty agreed • Royal College GPs • College Emergency Medicine • Royal College Obstetrics & Gynaecology • Royal College Paeds & Child Health • Royal College Surgeons

  21. Recent reports/publicity • CEM • RCP Future Hospital Commission • RCP, Dr Andrew Goddard, to NHS employers, 2011: • Jeremy Hunt • Times • Grauniad • TorygraphBBC/ITV/radio ++

  22. Conclusion • PA courses going well (with some hiccups) • Newly qualified PAs will still be beginners • BUT • Can make a substantial contribution to continuity for - patients - health care teams • Profession thriving • Numbers rising • Not ‘the’ answer; but part of the answer

  23. Australia England USA 40 years100, 000 PAs certified1PA:9 MDs qualifying Canada Scotland South Africa Netherlands Taiwan NZ &&&

  24. Thank you j.v.parle@bham.ac.uk More info: www.UKAPA.co.uk www.ukiubpae.sgul.ac.uk/

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